Diagnostic value of FNA in assessment of thyroid nodules Comparing cytology study with histology study

Introduction : The main role of fine needle aspiration cytology (FNAC) lies in the differentiating between a malignant and benign thyroid nodule. It greatly influences the treatment decision. Aim : This study aimed to evaluate the accuracy of fine needle aspiration cytology (FNAC) in the diagnosis of thyroid nodules by evaluating the cytology–histopathology correlation . Materials and Methods : This is a prospective study of 49 diagnosed cases of thyroid nodules who underwent FNAC and histological study of surgical biopsies for diagnosis at Tishreen University Hospital , during the period between march 2017 – march 2018 .The results were categorized according to Betheseda classification into: insufficient for diagnosis, benign, follicular lesion of undetermined significance, follicular neoplasm, suspicious for malignancy, and malignant sampling. The final histologic diagnosis was considered the gold standard. Results : The study included 49 cases presented with thyroid nodules who underwent diagnostic thyroid FNAC. Female to male ratio was 7.2:1, and the mean age was 43.6 years. Thirty –nine cases (79.6%) were diagnosed as benign, 3 cases (6.1%) as unsatisfactory , 2 cases (4.1%) as follicular neoplasm, 2 cases (4.1%) as suspicious for malignancy, 2 cases (4.1%) as malignant, and 1 case (2%) as follicular lesion of undetermined significance. Nodular goitre represented the majority of benign cases (62.8%), while papillary carcinoma was the most frequent malignant lesion (83.3%). Cytologic diagnoses were compared with their corresponding final histologic ones. FNAC achieved a sensitivity of 83.3%, a specificity of 97.4%, a positive predictive value of 83.3%, a negative predictive value of 97.4%, a false positive rate of 2.5% , a false negative rate of 16.6% , and a total accuracy of 95.5%. Conclusion : FNA cytology is a sensitive, specific, and accurate initial diagnostic test for the evaluation of patients with thyroid nodules.

Diagnostic Value of Cytology in the Evaluation of the Biliary Tree Strictures

This research is designed to study the diagnostic yield of brush cytology for biliary strictures. Brush cytology technique is of a great value to provide cytological samples during ERCP for patients with biliary strictures . The study included 34 patients with biliary stricture, ERCP was performed to all patients and cellular samples were taken using a brush for cytology . During the study period (one year) , the final diagnosis was made using a systematic approach based on clinical, radiological, laboratory or histopathological diagnosis . Sensitivity and specificity of brush cytology were studied . The sensitivity of biliary brushing was 57.1% , specificity was 100%, positive predictive value was 100% , negative predictive value was 76.9% and accuracy was 82% . Conclusions: Brush cytology has a very high specificity but an intermediate sensitivity for the diagnosis of malignant biliary strictures . Despite that , brush cytology is of a high diagnostic utility to distinguish between malignant and benign causes of biliary strictures .